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Cold weather, medicine stock-outs and lack of health workers - especially those trained in mental health care - are worrying the few local NGOs working with the hardest-to-access communities of displaced people in Myanmar's northern Kachin State.

Some 75,000 people have been displaced following the June 2011 collapse of a 17-year ceasefire between the government and Kachin Independence Army (KIA), which has been fighting for greater autonomy for decades.

As fighting continues, psychological fallout from a seemingly open-ended conflict is growing, said a local NGO umbrella group.

"Some students are having no interest in schooling and are refusing to go to school. They are listless - gazing somewhere. At night, they cry and sleep-walk," said May Li Awng, director of Wun Pawng Ninghtoi ("Light of Kachin" - WPN), a volunteer group of eight local NGOs and charity groups that has been working in Kachin's conflict zones since fighting broke out June 2011.

"Close to 50 percent of IDPs [internally displaced persons] are suffering from depression and other psychological impacts," said Moon Nay Li, coordinator of the Kachin Women's Association of Thailand (KWAT) in the northern Thai city of Chiang Mai. While KWAT has not conducted any formal survey, she said her estimate was based on work in 30 IDP camps along the China-Myanmar border plus relief provided through youth and women's groups in KIA-controlled areas.

Trauma

"We don't have the human resources to heal such traumatized cases," said May Li Awng. "All of the groups [donors] are just interested in giving material assistance. Few are interested in such issues."

She had not heard of the psychosocial support which the UN Children's Fund (UNICEF) has helped provide to 11,000 under-five children since March 2012.

Singapore Red Cross is considering directing $1.8 million of $2 million given to Myanmar Red Cross to provide psychosocial services for the war-affected displaced in Kachin State.

It is not just the civilians who are affected, but also those serving them, said KWAT's coordinator, Moon Nay Li. "The war is ongoing. They [health staff] have to listen to many problems of IDPs. They also want the training for trauma healing," she said.

Some 31,000 IDPs are in government-controlled areas, including Ja Mai Kaung (known locally as Dukataung) IDP camp in Kachin State's capital, Myitkyina, which has some 750 people. Here a man and a woman remain in shock after seeing government security forces arrest and torture a campmate suspected of having ties to KIA. Another woman tries to escape the camp nightly, fearing a similar fate.

Nearby is Tu Mai, who never feels safe. Even while walking around his hut, he peers left and right repeatedly, suspecting someone may harm him. "I cannot sleep at night," said the emaciated 47-year-old father of two, staring out from the hollow eyes of an insomniac. "I have to wait and watch my wife the whole night so that she can't betray me."

Health needs could multiply

Crowded living conditions, poor sanitation and hygiene, lack of clean water, and insufficient food and nutrition are causing outbreaks of diarrhoea, respiratory infections, skin diseases and malaria, according to KWAT.

Health workers warn humanitarian needs will multiply as cold weather approaches and temperatures drop to as low as eight degrees Celsius from November to February; IDP camps are already facing medicine shortages as the number of displaced persons and outbreaks of common illnesses climb.

The shortages are most acute in hard-to-reach areas both within government-controlled and KIA-controlled areas.

While health workers can regularly reach children in easier-to-reach camps with polio and measles vaccinations, the youngest IDPs in remote areas with poor road access and ongoing fighting are unlikely to have any health care, much less of the preventative kind, said aid workers.

"There are not enough medicines even to cure common sickness in the hard-to-reach areas," said Lama Yaw of Kachin Baptist Convention (KBC), a prominent faith-based group working in IDP camps both in government and KIA-controlled areas. Most residents in Kachin State identify themselves as Christian.

He also added that there are not enough health workers in remote areas. The situation worsens when violence forces the government to transfer out health workers.

Before fighting flared last June, there were some 1,000 health workers in all of Kachin State to cover a population of 1.4 million people, a shortage considered "critical" by the World Health Organization.